Pancreatic cysts are saclike pockets of fluid on or in your pancreas, a large organ behind the stomach that produces hormones and enzymes that help digest food.
Most pancreatic cysts aren't cancerous, and many don't cause symptoms. They're typically found during imaging testing for another problem. Some are actually noncancerous (benign) pockets of fluids lined with scar or inflammatory tissue, not the type of cells found in true cysts (pseudocysts).
But some pancreatic cysts can be or can become cancerous. Your doctor might take a sample of the pancreatic cyst fluid to determine if cancer cells are present. Or your doctor might recommend monitoring a cyst over time for changes that indicate cancer.
You may not have symptoms from pancreatic cysts, which are often found when imaging tests of the abdomen are done for another reason.
When signs or symptoms of pancreatic cysts do occur, they typically include:
- Persistent abdominal pain, which may radiate to your back
- A mass you can feel in your upper abdomen
- Nausea and vomiting
When to see a doctor
Rarely, cysts can become infected. See a doctor if you have a fever and persistent abdominal pain.
A ruptured pseudocyst can be a medical emergency, but fortunately is rare. Fluid released by the pseudocyst can damage nearby blood vessels and cause massive bleeding. A ruptured pseudocyst can also cause infection of the abdominal cavity (peritonitis). Seek emergency medical treatment if you have signs or symptoms of internal bleeding and shock, including:
- Severe abdominal pain
- Decreased consciousness
- Weak and rapid heartbeat
- Vomiting of blood
The cause of most pancreatic cysts is unknown. Some cysts are associated with rare illnesses including von Hippel-Lindau disease, a genetic disorder that can affect the pancreas and other organs.
Pseudocysts often follow a bout of a painful condition in which digestive enzymes become prematurely active and irritate the pancreas (pancreatitis). Pseudocysts can also result from injury to the abdomen, such as from a car accident.
Heavy alcohol use and gallstones are risk factors for pancreatitis, and pancreatitis is a risk factor for pseudocysts. Abdominal injury is also a risk factor for pseudocysts.
Here's some information to help you get ready for your appointment.
What you can do
- Write down your symptoms, including when they started and whether they've changed or worsened over time.
- Write down key personal information, including a history of injury to your abdomen.
- Make a list of all medications, vitamins and supplements you take.
- Write down questions to ask your doctor.
Some basic questions include:
- What is the most likely cause of my condition?
- What tests do I need?
- What type of cyst do I have?
- Is it likely to become cancerous?
- If I need surgery, what will my recovery be like?
- What follow-up care will I need?
- I have other conditions. How can I manage them together?
Don't hesitate to ask other questions, as well.
What to expect from your doctor
Your doctor is likely to ask you questions about your symptoms, such as:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Where do you feel your symptoms the most?
- What, if anything, seems to improve your symptoms?
- What, if anything, seems to worsen your symptoms?
- Have you had pancreatitis?
- How many alcoholic drinks do you consume daily?
- Do you have gallstones?
Pancreatic cysts are diagnosed more often than in the past because improved imaging technology finds them more readily. Many pancreatic cysts are found during abdominal scans for other problems.
The main challenge in diagnosis is to determine whether the cyst might become cancerous. These procedures are often used to help with diagnosis and treatment planning:
- Medical history. Previous abdominal injury or pancreatitis might indicate a pseudocyst.
- CT scan. This imaging test can provide detailed information about the size and structure of a pancreatic cyst.
- MRI scan. This imaging test can highlight subtle details of a pancreatic cyst, including whether it has any components that suggest a higher risk of cancer.
- Endoscopic ultrasound. This test, like MRI, can provide a detailed image of the cyst. Also, fluid can be collected from the cyst for analysis in a laboratory for possible signs of cancer.
The characteristics and location of the pancreatic cyst, with your age and sex, can help doctors pinpoint the type of cyst you have:
- Serous cystadenoma can become large enough to displace nearby organs, causing abdominal pain and a feeling of fullness. Serous cystadenomas occur most frequently in women older than 60 and only rarely become cancerous.
- Mucinous cystadenoma is usually situated in the body or tail of the pancreas and occurs most often in middle-aged women. Mucinous cystadenoma is precancerous, which means it might become cancer if left untreated. Larger cysts might already be cancerous when found.
- Intraductal papillary mucinous neoplasm (IPMN) is a growth in the main pancreatic duct or one of its side branches. IPMN may be precancerous or cancerous. It occurs most often in men and women older than 50. Depending on its location and other factors, IPMN may require surgical removal.
- Papillary cystic tumor is usually situated in the body or tail of the pancreas and occurs most often in women younger than 35. Also known as papillary cystic neoplasm, it's rare and usually cancerous.
- Cystic islet cell tumor is mostly solid but can have cystlike components. Cystic islet cell tumors are rare. They can be confused with other pancreatic cysts and may be precancerous or cancerous.
Watchful waiting or treatment depends on the type of cyst you have, its size, its characteristics and whether it's causing symptoms.
A benign pseudocyst, even a large one, can be left alone as long as it isn't bothering you. Serous cystadenoma rarely becomes cancerous, so it also can be left alone unless it causes symptoms or grows. But all pancreatic cysts should be monitored.
A pseudocyst that is causing bothersome symptoms or growing larger can be drained. A small flexible tube (endoscope) is passed through your mouth to your stomach and small intestine. The endoscope is equipped with an ultrasound probe (endoscopic ultrasound) and a needle to drain the cyst. Sometimes drainage through the skin is necessary.
Surgery might be needed to remove an enlarged pseudocyst or a serous cystadenoma that's causing pain or other symptoms. Other types of pancreatic cysts generally require surgical removal because of the risk of cancer.
A pseudocyst may recur if you have ongoing pancreatitis.
The best way to avoid pseudocysts is to avoid pancreatitis, which is usually caused by gallstones or heavy alcohol use. If gallstones are triggering pancreatitis, you may need to have your gallbladder removed. If your pancreatitis is due to alcohol use, not drinking can reduce your risk.
Sept. 19, 2015
- Khalid A, et al. Classification of pancreatic cysts. http://www.uptodate.com/home. Accessed June 4, 2015.
- Khalid A, et al. Pancreatic cystic neoplasms. http://www.uptodate.com/home. Accessed June 4, 2015.
- Kadiyala V, et al. Endosonography in the diagnosis and management of pancreatic cysts. World Journal of Gastrointestinal Endoscopy. 2015;7:213.
- Friedel DM, et al. Pancreatic cystic neoplasms. Southern Medical Journal. 2010;103:51.
- Howell DA, et al. Walled-off pancreatic fluid collections (including pseudocysts). http://www.uptodate.com/home. Accessed June 4, 2015.
- Freedman SD, et al. Etiology and pathogenesis of acute pancreatitis in adults. http://www.uptodate.com/home. Accessed June 5, 2015.
- Khanna AK, et al. Pancreatic pseudocyst: Therapeutic dilemma. International Journal of Inflammation. 2012;2012:1.